Neuro: Brain Flashcards
1
Q
what is massa intermedia?
A
gray + white matter struct –> thru 3rd vent –> connect bilat thalami
2
Q
brain edema –> 3 types?
A
- cytotoxic edema
- vasogenic edema
- interstitial edema
3
Q
cytotoxic edema –> MOA?
A
cell death –> damage Na-K ATPase pumps –> water ions trapped inside swollen cells
4
Q
vasogenic edema –> MOA?
A
inc capillary permeability –> interstitial edema
5
Q
cytotoxic edema –> MCC?
A
infarct
6
Q
vasogenic edema –> MCC? (3)
A
- neoplasm
- infx
- infarct
7
Q
interstitial edema –> MOA? MCC?
A
imbalance in CSF flow
obstructive hydrocephalus
8
Q
interstitial edema –> imaging appearance?
A
periventricular fluid (transependymal flow of CSF)
9
Q
subfalcine herniation –> comp? (1)
A
compress ACA
10
Q
uncal herniation –> comp? (4)
A
- CN III paresis
- compress PCA
- Duret hemorrhage
- compress contralat cerebral peduncle
11
Q
tonsillar herniation –> comp? (1)
A
compress medulla
12
Q
CN III paresis –> clinical presentation? (2)
A
- pupil dilate
- eye –> down & out
13
Q
upward transtentorial herniation –> comp? (1)
A
compress aqueduct –> hydrocephalus
14
Q
what is communicating hydrocephalus?
A
no obstructing lesion –> venticles enlrg
15
Q
communicating hydrocephalus –> 2 causes?
A
- subarachnoid hemorrhage
- normal pressure hydrocephalus
16
Q
subarachnoid hemorrhage –> communicating hydrocephalus –> MOA?
A
impede arachnoid granulation from resorb CSF
17
Q
what is T1? T2?
A
- T1: longitudinal recovery/relaxation
- T2: transverse relaxation
18
Q
T1 shortening vs prolongation –> hypo or hyper-intense?
A
- T1 short –> hyper
- T1 prolong –> hypo
19
Q
T2 shortening vs prolongation –> hypo or hyper-intense?
A
- T2 short –> hypo
- T2 prolong –> hyper
20
Q
what is optic neuritis?
A
optic N –> inflamm –> non-neoplastic
21
Q
optic neuritis –> clinical presentation? (3)
A
- pain
- subacute vision loss
- reduce color perception
22
Q
optic neuritis –> MC etiology? less common etiologies? (4)
A
- # 1 mult sclerosis
- viral
- sarcoid
- vasculitis
- toxin
23
Q
optic neuritis + spinal demyelination –> dx?
A
Devic synd
24
Q
MRI orbit –> optic neuritis –> next step?
A
MRI brain & spine –> look for intracranial plaques
25
optic neuritis --> MR appearance? T2 signal? enhance?
- enlrg optic N
- T2 hyper
- active dz --> enhance
26
globe --> MC 1ary malig?
retinoblastoma
27
retinoblastoma --> epidemiology?
<5yo
28
retinoblastoma --> classic CT appearance?
normal size globe --> retinal mass --> hyperdense --> enhance --> calc
29
what is trilateral retinoblastoma?
- bilat retinoblastoma
| - pineal gland --> pineoblastoma
30
what is quadrilateral retinoblastoma?
- bilat retinoblastoma
- pineal gland --> pineoblastoma
- suprasellar retinoblastoma
31
what is Coat dz?
retina --> vascular dz --> lipoproteinaceous subretinal exudate --> retina detach
32
Coat dz --> epidemiology?
slightly older than retinoblastoma --> M
33
Coat dz --> imaging appearance?
normal size globe --> subretinal soft tissue --> not enhance
34
premature infant --> prolong O2 therapy --> comp? (1)
retinopathy of prematurity
35
retinopathy of prematurity --> findings? (4)
- bilat microphthalmia
- abnormal vascular developmt
- hemorrhage --> high attenuation & calc
- retina detach
36
retinopathy of prematurity --> natural progression?
phthisis bulbi
37
full term infant --> retina detach, hemorrhage --> loss of vision --> dx?
persistent hyperplastic primary vitreous (PHPV)
38
what is persistent hyperplastic primary vitreous (PHPV)?
vitreous --> persistent embryonic vasculature --> hemorrhage, cataract, retina detach --> vision loss
39
persistent hyperplastic primary vitreous (PHPV) --> imaging features? (3)
- microphthalmia
- vitreous --> hyperdense
- no calc
40
most brain lesion --> T1 signal? T2?
- T1 hypo
| - T2 hyper
41
T1 short (hyper) --> cause? (8)
- gad contrast
- fat
- protein
- blood --> paramagnetic stage --> metHb --> intra & extra-cell
- melanin
- mineral (copper, iron, mangenese)
- slow flow blood
- rare --> calcium
42
T2 short (hypo) --> cause? (6)
- blood --> most paramag stages --> except hyperacute blood & extracell metHb
- calc
- fibrous lesion
- high cellular tumor: high nucleus:cytoplasm ratio --> low water content --> ie. lymphoma, medulloblastoma
- vasc flow void
- mucin --> dessicated
43
what is fluid attenuation inversion recovery (FLAIR)?
T2 --> water suppressed (based on T2 charact)
44
brain --> white vs gray matter --> T1 signal?
- white matter: bright
| - gray: darker
45
brain --> white vs gray matter --> FLAIR signal?
- white matter: darker
| - gray: bright
46
MRI seq with highest signal to noise ratio?
proton density (PD)
47
proton density (PD) --> useful for eval of what condition?
mult sclerosis
48
diffusion MRI --> DWI & ADC --> based on what characteristic?
water proton --> Brownian motion
49
diffusion MRI --> DWI & ADC --> CSF vs pathologic process --> signal attenuation?
- CSF --> most signal attenuation --> most signal loss
| - path process --> less Brownian motion --> less diffusivity --> less signal loss --> DWI hyperintense
50
what is T2 shinethru?
DWI is T2 weighted --> T2 hyper lesion --> hyper on DWI, even if not restricted diffusion
51
restricted diffusion --> ddx? (6)
- acute stroke
- bacterial abscess
- cellular tumor --> ie lymphoma, medulloblastoma
- epidermoid cyst
- herpes encephalitis
- Creutzfeldt-Jakob dz
52
gradient recall echo (GRE) --> what creates blooming artifact? (2)
- hemosiderin
| - Ca
53
GRE --> mult dark spots --> ddx? (5)
- HTN microbleed
- cerebral amyloid angiopathy
- familial cerebral cavernous malformation
- axonal shear injury
- mult hemorrhagic mets
54
cerebral amyloid angiopathy --> GRE --> mult dark spots --> location?
subcortical white matter --> usu parietal & occipital lobes
55
glioblastoma vs mets --> how differentiate on MR spectroscopy?
- glioblastoma --> infiltrative --> gradual transition from abnormal to normal spectroscopy
- mets --> more abrupt transition
56
what is N-acetylaspartate (NAA)?
normal marker of neuronal viability --> dec in most abnormalities
57
most tumor --> N-acetylaspartate (NAA) inc/dec? choline (cho)?
- NAA dec
| - choline inc
58
NAA elevated --> ddx? (1)
Canavan dz --> dysmyelinating disorder
59
lactate "doublet" --> ddx? (1)
high grade tumor --> anaerobic metabolism
60
MRI brain --> parenchymal enhance --> MOA? cause? (5)
blood brain barrier disrupt:
- infx
- inflamm
- neoplasm
- trauma
- vascular
61
MRI brain --> regions w no BBB --> normally enhance? (5)
- choroid plexus
- pituitary gland
- pineal gland
- tuber cinereum --> inf hypothalamus
- area postrema --> inf 4th ventricle
62
MRI brain --> periventricular enhance --> ddx? (4)
- primary CNS lymphoma
- infx ependymitis
- primary glial tumor
- mult sclerosis
63
primary CNS vs systemic lymphoma --> leptomeningeal involvemt?
- primary CNS --> rarely involve meninges
| - systemic lymphoma --> brain mets --> commonly involve leptomeninges
64
infx ependymitis --> MC org?
CMV
65
infx ependymitis --> imaging appearance?
ventricle margins --> thin linear enhance
66
gyrus enhance --> ddx? (5)
- herpes encephalitis
- meningitis
- subacute infarct
- post reversible encephalopathy synd (PRES)
- SMART synd
67
herpes encephalitis --> which locations affected 1st? (2)
- medial temporal lobe
| - cingulate gyrus
68
what is SMART synd?
stroke like migraine attacks after rtx
69
ring enhance --> ddx? (7)
MAGIC DR:
- mets
- abscess
- glioma
- infarct --> subacute basal ganglia
- contusion --> subacute-chronic
- demyelination
- radiation
70
dura enhance --> ddx? (5)
- intracranial hypotension
- postop
- post lumbar puncture
- meningeal neoplasm
- hypertrophic pachymeningitis
71
hypertrophic pachymeningitis --> etiology? (4)
- infx --> TB/fungal, syphilis
- inflamm --> RA, granulomatosis w polyangiitis
- sarcoid
- idiopathic
72
what is pachymeninges? leptomeninges?
- pachy --> dura
| - lepto --> pia & arachnoid
73
leptomeningeal enhance --> ddx? (4)
- meningitis
- viral encephalitis
- leptomeningeal mets
- inflamm amyloid
74
subarachnoid space --> FLAIR hyper --> ddx? (7)
- meningitis
- leptomeningeal mets
- subarachnoid hemorrhage
- slow vascular flow
- O2 tx
- propofol tx
75
internal carotid A --> segments? (4)
- cervical
- petrous
- cavernous
- supraclinoid
76
A1 segmt --> br?
recurrent A of Heubner
77
what is A of Percheron?
variant: P1 PCA --> dominant thalamic perforator --> supply b/l ventromedial thalami
78
what is fetal PCA?
normal variant: ICA --> enlrged P-comm --> no PCA
79
what is azygos ACA?
normal variant: --> b/l ACA converge into 1
80
azygos ACA --> assoc anomaly? (3)
- holoprosencephaly
- neuronal migration anomaly
- aneurysm formation
81
recurrent A of Heubner --> supplies what struct? (2)
- caudate head
| - internal capsule --> ant limb
82
MC persistent carotid-basilar connection?
persistent trigeminal A
83
persistent trigeminal A --> assoc comp? (1)
aneurysm
84
persistent trigeminal A --> sign?
angio --> lat view --> "tau" sign
85
acute stroke --> perfusion imaging --> what is cerebral blood vol (CBV)?
blood vol per unit brain tissue
86
acute stroke --> perfusion imaging --> what is cerebral blood flow (CBF)?
vol of blood flowing per unit of brain tissue
87
acute stroke --> perfusion imaging --> what is mean transit time (MTT)?
avg time for contrast bolus to transverse a voxel
88
acute stroke --> perfusion imaging --> what is time to maximum (Tmax)/time to peak (TTP)?
time from scan start to max contrast bolus in voxel
89
acute stroke --> perfusion imaging --> how are CBF, CBV, and MTT related?
central volume eqn:
CBF = CBV/MTT
90
acute stroke --> perfusion imaging --> infarct core --> finding?
marked dec CBF --> matched dec CBV
91
acute stroke --> perfusion imaging --> ischemic penumbra --> finding? (2)
- mild dec CBF --> mismatch inc/normal CBV
| - inc MTT & Tmax
92
stroke --> dating?
- DWI bright, ADC dark --> 10days
- T1 dark --> 16hr
- T2 bright --> 8hr
- FLAIR bright --> 6hr
93
subacute infarct --> what is 2-2-2 rule?
enhance:
- begin at 2 days
- peak at 2wk
- resolve by 2mo
94
subarachnoid hemorrhage --> comp? (3) which is MC?
- #1 vasospasm --> delayed ischemia
- hydrocephalus
- superficial siderosis
95
aneurysm --> subarachnoid hemorrhage --> hemorrhage location --> indicates aneurysm of what vessel?
- ant interhemispheric fissure
- suprasellar cistern
- Sylvian fissure
- perimesencephalic cistern
- ant interhemispheric fissure --> A-comm
- suprasellar cistern --> P-comm
- Sylvian fissure --> MCA
- perimesencephalic cistern --> basilar tip
96
what is perimesencephalic subarachnoid hemorrhage?
pattern of nontraumatic SAH --> likely venous origin --> benign prognosis
97
what is reversible cerebral vasoconstriction synd (RCVS)?
nontraumatic, nonaneurysmal --> SAH & ischemia
98
MC cranial N palsy from giant aneurysm?
P-comm aneurysm --> CN III palsy
99
isolated intraventricular hemorrhage in 4th ventricle --> ddx? (1)
PICA aneurysm rupture
100
mycotic aneurysm --> etiology?
septic emboli
101
what is oncotic aneurysm?
aneurysm caused by neoplasm
102
what is AVM?
congenital --> high flow vasc malformation --> directly connecting A & V --> no intervening capillary
103
what is dural AVF (dAVF)?
high flow vasc malformation --> meningeal arterioles & dural venules --> AV shunt
104
dural AVF (dAVF) --> #1 prognostic factor?
presence & degree of cortical venous drainage
105
dural AVF (dAVF) --> what is a subtype of dAVF?
carotid-cavernous fistula (CCF)
106
what is V of Galen malformation?
high flow vasc malformation --> thalmoperf br & deep venous system --> AVF --> enlrg median prosencephalic V
107
CNS --> vasc malformation --> high flow (2) vs low flow (3) --> ddx?
high flow:
- AVM
- dural AVF
low flow:
- cavernous malformation (cavernoma)
- developmental venous anomaly (venous angioma)
- capillary telangiectasia
108
cavernous malformation (cavernoma) --> comp? (2)
- hemorrhage --> small risk
| - sz
109
cavernous malformation (cavernoma) --> assoc anomaly?
developmental venous anomaly (venous angioma)
110
mult cavernous malformation (cavernoma) --> ddx? (1)
familial cerebral cavernous malformation synd
111
what is cavernous malformation (cavernoma)?
vasc hamartoma
112
cavernous malformation (cavernoma) --> assoc RF? (1)
brain rtx
113
cavernous malformation (cavernoma) --> CT appearance?
well-circumscribed rounded hyperdense lesion
114
cavernous malformation (cavernoma) --> usu diagnostic on CTA --> T/F?
F
usu occult on vasc imaging
115
cavernous malformation (cavernoma) --> MRI appearance? T1/T2? enhance?
- T1/T2 mixed "popcorn-like" signal --> blood of varying ages
- dark rim of hemosiderin
- no enhance
116
what is developmental venous anomaly (venous angioma)?
abnormal V --> provide functional drainage to normal brain
117
developmental venous anomaly (venous angioma) --> usu only seen on contrast-enhanced or susceptibility weighted imaging --> T/F?
T
118
developmental venous anomaly (venous angioma) --> imaging appearance?
radially oriented V --> caput medusa appearance
119
cavernous malformation (cavernoma) --> Do Not Touch lesion --> T/F?
F
120
developmental venous anomaly (venous angioma) --> Do Not Touch lesion --> T/F?
T
121
capillary telangiectasia --> Do Not Touch lesion --> T/F?
T
122
what is capillary telangiectasia?
low flow vasc malformation --> dilated capillaries w interspersed normal brain --> asx
123
capillary telangiectasia --> usu diagnostic on CTA --> T/F?
F
occult on vasc imaging
124
developmental venous anomaly (venous angioma) --> usu diagnostic on CTA --> T/F?
T
125
capillary telangiectasia --> MRI appearance? T2? GRE? enhance?
- occult on T2/FLAIR
- GRE --> blooming artifact
- contrast --> "brush stroke"-like lesion
126
capillary telangiectasia --> MC location?
brainstem
127
what is venous angle?
intersect of septal V & thalmostriate V --> angio landmark for foramen of Monro
128
deep venous sinus or cortical V --> thrombosis --> RF? (5)
- preg/OCP
- thrombophilia
- malig
- infx
129
noncontrast CT --> venous thrombosis --> sign?
"cord" sign --> inc density of thrombosed sinus/cortical V
130
venous thrombosis --> comp?
venous HTN --> infarct, hemorrhage
131
venous thrombosis --> pattern of venous infarction?
- sup sagittal sinus
- deep venous system
- transverse sinus
- sup sagittal sinus --> parasagittal high convexity cortex
- deep venous system --> b/l thalamus
- transverse sinus --> post temporal lobe
132
CTA brain --> what is spot sign?
small enhancing focus w/in hemorrhage --> not seen on noncontrast --> sep from adj vessels --> reflect active hemorrhage
133
evolution of blood product --> phases? how relate to acuity of hematoma? (5)
1) intracell oxyHb --> hyperacute (0-6hr)
2) intracell deoxyHb --> acute (6-72hr)
3) intracell metHb --> early subacute (3day-1wk)
4) extracell metHb --> late subacute (1wk-months)
5) hemosiderin & ferritin --> chronic
134
blood product --> dating --> used for intra vs extra-axial vs both?
intra-axial only
135
parenchymal hematoma --> dating --> T1/T2 signal?
IdDy BiDy BaBy DaDy:
- acute --> T1 iso, T2 dark
- early subacute --> T1 bright, T2 dark
- late subacute --> T1 bright, T2 bright
- chronic --> T1 dark, T2 dark
136
what is cerebral amyloid angiopathy? comp?
small & med A --> amyloid accum in wall --> weak wall --> inc risk of hemorrhage
137
cerebral amyloid angiopathy --> main clinical clue?
elder --> normotensive
138
cerebral amyloid angiopathy --> microhemorrhages --> location?
lobar, cortical, subcortical
139
CNS vasculitis --> most sens imaging modality? finding?
conventional angiography --> multifocal stenosis/dilation
140
CNS vasculitis --> MC presentation?
cerebral ischemia
141
CNS vasculitis --> standard MR finding?
basal ganglia & subcortical white matter --> multifocal T2 bright
142
MC hemorrhagic neoplasm?
glioblastoma
143
hemorrhagic brain mets --> primary CA ddx? (6)
- melanoma
- RCC
- chorioCA
- thyroid
- breast
- lung
144
what is moyamoya dz?
non-atherosclerotic vasculopathy --> intracrnial ICA & prox br --> progressive stenosis --> comp prolif of collateral vessels --> esp lenticulostriate & other perforating vessels of basal ganglia --> fragile
145
what is moyamoya synd?
2ary cause --> ie. sickle cell, NF1, rtx, Down synd --> moyamoya vasc findings
146
moyamoya dz --> classic angio finding?
enlrg lenticulostriate perforating collaterals --> "puff of smoke" appearance
147
moyamoya dz --> classic FLAIR finding?
sulci --> cortical A br --> slow flow --> bright tubular branching --> "ivy" sign
148
moyamoya dz --> comp? MC location?
post circ --> aneurysm formation
149
severe moyamoya dz --> tx?
ECA to MCA bypass
150
intracranial hemorrhage --> what is swirl sign?
hematoma --> mixed high & low density --> active bleeding
151
diffuse axonal injury (traumatic axonal injury) --> characteristic locations --> least to worst in prognosis?
- grade 1: cerebral hemisphere --> gray-white jx
- grade 2: corpus callosum
- grade 3: dorsolat, rostral midbrain
152
diffuse axonal injury (traumatic axonal injury) --> FLAIR? SWI/GRE? DWI?
- restricted diffusion
- FLAIR bright
- SWI/GRE blooming if hemorrhagic axonal injury
153
extra-axial mass --> clues that extra-axial? (3)
- CSF cleft
- gray matter bw mass
- dural tail
154
cerebellopontine angle --> mass --> ddx? (3)
- vestibular schwannoma
- meningioma
- epidermoid cyst
155
pineal region --> mass --> ddx? (2)
- germ cell tumor --> ie. germinoma
| - pineal tumor --> ie. pineoblastoma
156
transcallosal (butterfly) mass? (3)
- glioblastoma
- 1ary CNS lymphoma
- demyelinating dz
157
MC cortical brain tumor? (4)
- pleomorphic xanthoastrocytoma
- dysembryoplastic neuroepithelial tumor
- oligodendroglioma
- ganglioglioma
158
MC 1ary central skull base tumor? (2)
- chordoma
| - chondrosarcoma
159
MC suprasellar tumor in adult? child?
- adult --> pit adenoma
| - child --> craniopharyngioma
160
MC post fossa tumor in adult? (2) child? (4)
adult:
- hemangioblastoma
- mets
child (BEAM):
- brainstem glioma (diffuse) - ependymoma
- astrocytoma (pilocytic)
- medulloblastoma
161
lat ventricle atrium --> MC purely intraventricular tumor in adult? (2) child? (1)
adult:
- meningioma
- degen choroid plexus cyst/xanthogranuloma
child:
- choroid plexus papilloma
162
MC mass of foramen of Monro in adult? child?
- adult: colloid cyst
| - child: subependymal giant cell astrocytoma
163
types of glial cells? (4)
- astrocyte
- oligodendrocyte
- ependymal cell
- choroid plexus cell
164
what is drop mets?
intracranial tumor --> disseminate to spine --> intradural extramedullary cmpt
165
what is gliomatosis cerebri?
diffuse glioma --> involve at least 3 lobes of brain
166
what is T2-FLAIR mismatch sign?
T2 hyper --> FLAIR central hypo --> highly specific for 1p19q non-co-deleted IDH-mutant astrocytoma
167
expansile cortical mass --> gyriform calcs --> dx?
1p19q-co-deleted IDH-mutant oligodendroglioma
168
supratentorial cortical tumors --> ddx? (6)
P-DOG MD:
- pleomorphic xanthoastrocytoma (PXA)
- dysembryoplastic neuroepithelial tumor (DNET)
- oligodendroglioma
- ganglioglioma
- multinodular and vacuolating neuronal tumor (MVNT)
- desmoplastic infantile astrocytoma and ganglioglioma (DIA/DIG)
169
pleomorphic xanthoastrocytoma (PXA) --> epidemiology? (2)
- child
| - YA
170
pleomorphic xanthoastrocytoma (PXA) --> MRI appearace? (3)
- mass --> avid enhance
- cyst formation
- dural tail
171
brain cortex --> solid & cystic lesion --> ddx? (2)
- pleomorphic xanthoastrocytoma (PXA)
| - ganglioglioma
172
dysembryoplastic neuroepithelial tumor (DNET) --> MRI appearance? T2? FLAIR? enhance?
- circumscribed bubbly appearance
- T2 bright
- FLAIR bright rim sign
- enhance
173
ganglioglioma --> freq assoc anomaly?
focal cortical dysplasia
174
hemangioblastoma --> assoc synd?
25% --> von Hippel-Lindau (VHL)
175
hemangioblastoma --> classic appearance?
cystic mass --> avid enhance mural nodule
176
diffuse midline glioma --> MRI appearance?
brainstem/diencephalon --> expansile solid or infiltrative mass --> FLAIR hyper
177
MC CNS embryonal tumor?
medulloblastoma
178
MC brain malig of child?
medulloblastoma
179
medulloblastoma --> CT density? T2? ADC? why?
hypercellular:
- CT slight hyperdense
- T2 hypo
- ADC dark
180
child --> MCC drop mets to spine?
medulloblastoma
181
<3yo --> lrg brain mass --> look like medulloblastoma --> ddx? (1)
atypical teratoid/rhabdoid tumor (AT/RT)
182
dysplastic cerebellar gangliocytoma (Lhermitte-Duclos) --> charact imaging finding?
cerebellar hemisphere --> thick folia --> "corduroy" or "tiger-stripe" appearance
183
dysplastic cerebellar gangliocytoma (Lhermitte-Duclos) --> adult onset --> assoc synd?
Cowden synd
184
Cowden synd --> synd?
- multiple hamartoma syndrome associated with benign mucocutaneous lesions like facial trichilemmomas
- breast CA
- thyroid cancer
185
child --> post fossa mass --> hyperattenuating on CT, low ADC on MR --> ddx? (1)
medulloblastoma
186
child --> post fossa mass --> cystic mass w enhancing mural nodule --> ddx? (1)
juvenile pilocytic astrocytoma
187
child --> post fossa mass --> intraventricular mass --> ddx? (1)
ependymoma
188
child --> post fossa mass --> cystic mass w enhancing mural nodule & flow voids --> ddx? (1)
hemangioblastoma
189
child --> post fossa mass --> h/o von Hippel-Lindau --> ddx? (1)
hemangioblastoma
190
child --> post fossa mass --> renal mass present --> ddx? (1)
atypical teratoid/rhabdoid tumor
191
adult --> post fossa mass --> h/o 1ary malig --> ddx? (1)
mets
192
adult --> post fossa mass --> h/o von Hippel-Lindau --> ddx? (1)
hemangioblastoma
193
adult --> post fossa mass --> minimal enhance --> ddx? (1)
astrocytoma
194
YA --> post fossa mass --> lateral location --> ddx? (1)
medulloblastoma
195
infant --> cystic mass w enhancing mural nodule --> supratentorial & cortical --> ddx? (1)
desmoplastic infantile astrocytoma/ganglioglioma
196
child-adol --> cystic mass w enhancing mural nodule --> cerebellar --> ddx? (1)
pilocytic astrocytoma
197
adol-YA --> cystic mass w enhancing mural nodule --> supratentorial & cortical --> ddx? (1)
pleomorphic xanthoastrocytoma, ganglioglioma
198
YA-middle age --> cystic mass w enhancing mural nodule --> cerebellar --> ddx? (1)
hemangioblastoma
199
intraventricular mass --> ddx? (4)
- ependymoma
- subependymoma
- medulloblastoma
- developmental/degen cyst
200
central neurocytoma --> typical imaging findings --> appearance? location? enhance? calcs?
- lobulated heterogenous, multicystic --> "bubbly", "Swiss cheese"
- lat ventricle --> attached to septum pellucidum
- mod enhance
- calcs common
201
intraventricular meningioma --> how differentiate from other intraventricular neoplasms? (2)
- hypercell
| - homogeneous enhance
202
adult --> MC choroid plexus mass?
choroid plexus xanthogranuloma (degen choroid plexus cyst)
203
what is choroid plexus xanthogranuloma (degen choroid plexus cyst)?
collection of cholesterol & lipid-laden histiocytes
204
types of choroid plexus tumors? (3)
- choroid plexus papilloma
- atypical choroid plexus papilloma
- choroid plexus CA
205
choroid plexus tumor --> charact MRI appearance?
intraventricular mass --> "cauliflower-like" --> avid enhance
206
choroid glioma --> cell origin?
lamina terminalis --> ependymal cells
207
choroid glioma --> tumor location?
ant 3rd ventricle --> assoc w hypothalamus
208
choroid glioma --> imaging appearance? CT density? T2? enhance?
circumscribed ovoid homogenous enhance mass:
- CT hyper
- T2 slight hyper
209
machine oil-like contents --> dx?
colloid cyst
210
1ary CNS lymphoma --> key imaging features? --> location? CT density? T2? diffusion? enhance?
- periventricular
- CT hyper (hypercell)
- T2 hypo
- restricted diffusion
- enhance
211
1ary CNS lymphoma --> hemorrhage or no hemorrhage?
no hemorrhage
212
1ary CNS lymphoma --> immunocompetent vs immunocomp --> mass apeparance?
- immunocompetent: homo enhance mass
| - immunocomp: ring enhance
213
1ary CNS lymphoma --> immunocomp --> assoc org?
EBV
214
HIV/AIDS --> ring enhance mass --> MCC? (2)
- lymphoma
| - toxo
215
HIV/AIDS --> ring enhance mass --> lymphoma vs toxo --> how to differentiate? (6)
- empirical toxo tx --> fu imaging
- MR DWI --> lymphoma more restricted diffusion
- MR perfusion --> lymphoma higher rCBV
- MR spectroscopy --> lymphoma elevated choline
- FDG PET --> lymphoma higher glucose metabolism
- thallium SPECT --> lymphoma more thallium uptake
216
2ary CNS lymhoma --> MC location?
extra-axial:
- leptomeninges
- dura
- skull
217
MC intracranial mets? (3)
- lung
- breast
- melanoma
218
solitary hemorrhagic brain neoplasm --> ddx? (2)
- mets
| - glioblastoma
219
mult dural masses --> ddx? (2)
- mult meningiomas
| - mets
220
leptomeningeal enhance & sulcal FLAIR hyper --> ddx? (2)
- meningitis --> infx/inflamm
| - leptomeningeal mets (carcinomatosis meningitis)
221
what is "mother in law" sign? dx?
mother in law --> come early, stay late
meningioma:
- early arterial enhance
- venous contrast retention
222
pineal region --> mass --> comp? (2)
- compress cerebral aqueduct --> noncomm hydrocephalus
| - compress tectum (quadrigeminal plate) --> Parinaud synd --> vertical gaze palsy
223
MC pineal region mass? (4)
- #1 benign cyst
- germ cell tumor
- pineal parenchymal tumor
- glioma
224
intracranial germ cell tumor --> MC location? 2nd MC?
- #1 pineal gland
| - #2 suprasellar region
225
pineal region --> germ cell tumor --> MC type? 2nd MC?
- #1 germinoma
| - #2 teratoma
226
what is germinoma?
extra-gonadal seminoma
227
pineal parenchymal tumor spectrum --> includes what tumor types?
- pineocytoma
- pineal parenchymal tumor or interm differentiation
- papillary tumor of the pineal
- pineoblastoma
228
pineal parenchymal tumor spectrum --> epidemiology?
- pineocytoma
- pineal parenchymal tumor or interm differentiation
- papillary tumor of the pineal
- pineoblastoma
- pineocytoma: adult
- pineal parenchymal tumor or interm differentiation: adult
- papillary tumor of the pineal: adult
- pineoblastoma: young child
229
pineal region mass --> how can differentiate germ cell tumor vs pineal parenchymal tumor on imaging?
- germ cell tumor: "engulf" pineal gland --> central calc
| - pineal parenchymal tumor --> "explode" --> peripherally displace physiologic calcs
230
demyelinating dz --> key imaging finding to differentiate from mass?
minimal mass effect relative to lesion size
231
mult sclerosis --> how differentiate active vs chronic lesion?
- active demyelination --> enhance
| - chronic lesion --> not enhance
232
mult sclerosis lesions --> common locations? (7)
- periventricular
- corpus callosum
- subcortical white matter
- temporal white matter
- brainstem
- cerebellum
- cervical spinal cord
233
what is central V sign? dx?
mult sclerosis --> white matter lesion --> FLAIR hyper --> central V is FLAIR hypo
234
mult sclerosis --> what is "black hole"?
T1 dark lesion --> assoc w more severe demyelination & axonal loss
235
what is concentric (Balo) sclerosis? pathogonomic finding?
very rare variant of MS --> alternating concentric bands of normal & abnormal myelin
236
what is NMO spectrum disease (NMOSD)?
demyelinating dz --> involve optic N & spinal cord
237
NMO spectrum disease (NMOSD) --> highly specific lab finding?
NMO-IgG
238
acute disseminated encephalomyelitis (ADEM) --> epidemiology? RF?
children --> after viral infx or vaccine
239
acute disseminated encephalomyelitis (ADEM) --> imaging findings can look like what other condition?
can look identical to MS
240
posterior reversible encephalopathy synd (PRES) --> MOA?
post circulation --> failed autoregulation --> resultant hyperperfusion --> vasogenic edema
241
recurrent episodes of stroke/TIA --> imaging --> always basal ganglia or subcortical white matter --> dx?
cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL)
242
cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL) --> synd? (4) MOA?
small vessel arteriopathy:
- recurrent stroke
- migraine
- subcortical dementia
- pseudobulbar palsy
243
cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL) --> highly sens & spec imaging finding?
ant temporal lobe or paramedial frontal lobe --> subcortical white matter --> symm T2 hyper foci
244
subcortical & deep white matter --> mult small T2 hyper foci --> how differentiate MS vs vasculitis?
- vasculitis --> may show foci of hemorrhage
| - MS --> no hemorrhage
245
what is progressive multifocal leukoencephalopathy (PML)?
immunocomp ie AIDS --> JC virus reactivate --> demyelinating dz --> no inflamm response
246
progressive multifocal leukoencephalopathy (PML) --> how dx?
CSF --> PCR --> JC virus DNA
247
progressive multifocal leukoencephalopathy (PML) --> MR appearance? mass effect? enhance?
- asymm multifocal white matter lesions --> usu subcortical U-fibers
- no enhance
- no mass effect
248
AIDS --> white matter lesions on MRI --> ddx? (2)
- PML
| - HIV encephalitis
249
AIDS --> white matter lesions on MRI --> PML
vs HIV encephalitis --> how to differentiate?
- location
- cerebral atrophy
HIV encephalitis:
- diffuse/symm bilat
- spare subcortical white matter
- cerebral atrophy
PML:
- asymm bilat
- involve subcortical white matter
- no cerebral atrophy in acute dz
250
subacute sclerosing panencephalitis (SSPE) --> org?
measles virus --> reactivate
251
whole brain rtx --> radiation injury --> what are the 3 phases? occur how long after rtx?
- acute phase: during or immed after rtx
- early delayed: wks - up to 6mo
- late delayed: 6mo to years
252
whole brain rtx --> radiation injury --> acute phase --> MOA? MRI findings?
endothelial injury --> edema --> white matter --> diffuse T2 hyper
253
whole brain rtx --> radiation injury --> early delayed phase --> MOA? MRI findings?
demyelination --> field of radiation --> white matter:
- inc T2 hyper
- inc size contrast-enhance lesions
254
whole brain rtx --> radiation injury --> late delayed phase --> MOA? MRI findings?
vascular changes:
- white matter change
- radionecrosis
- vasc lesions --> ie capillary telangiectasis, cavernous malformation
255
whole brain rtx --> radiation injury --> late delayed phase --> radiation necrosis --> imaging appearance? tx?
peripheral enhance, central necrotic lesion
corticosteroid
256
ctx & rtx --> pseudoprogression --> peaks when?
3-6mo after tx
257
ctx & rtx --> pseudoprogression vs progressive dz --> relative cerebral blood vol?
progressive dz --> higher relative cerebral blood vol
258
Wernicke encephalopathy --> synd? (3)
- ataxia
- confuse
- oculomotor dysfx
259
Wernicke encephalopathy --> etiology?
thiamine (vitB1) def
260
Wernicke encephalopathy --> MRI appearance?
- FLAIR?
- DWI?
- contrast?
symm bilat:
- FLAIR hyper
- restrict diffusion
- enhance
261
Wernicke encephalopathy --> MC locations? (5)
- medial thalami
- mamillary bodies
- hypothalamus
- tectal plate
- periaqueductal gray matter
262
hyperPTH --> CNS --> main imaging finding?
basal ganglia --> coarse Ca deposition
263
basal ganglia --> coarse Ca deposition --> ddx? (2)
- hyperPTH
| - Fahr dz
264
chronic hepatic encephalopathy --> charact imaging finding?
globus pallidus & substantia nigrae --> symm T1 hyper
265
acute hepatic encephalopathy (hyperammonemic encephalopathy) --> charact imaging finding?
symm & bilat --> insula & cingulate gyrus:
- FLAIR hyper
- restricted diff
266
uremic encephalopathy --> MC location?
bilat symm basal ganglia
267
what is lentiform fork sign? dx?
uremic encephalopathy + concurrent metabolic acidosis --> white matter surrounding lentiform nuclei --> FLAIR hyper
268
hypoglyemic encephalopathy --> MC imaging pattern? MC location?
parieto-occipital & temporal --> gray matter:
- FLAIR hyper
- restricted diff
269
diabetic striatopathy (hyperglycemic-induced hemichorea-hemiballismus) --> pathognomonic imaging findings?
striatum --> unilat:
- CT hyper
- T1 hyper
270
circulatory or resp fail --> global hypoxia/anoxia --> type of encephalopathy?
hypoxic ischemic encephalopathy (HIE)
271
hypoxic ischemic encephalopathy (HIE) --> common locations? (3)
gray matter:
- cerebral cortex
- hippocampus
- basal ganglia
272
hypoxic ischemic encephalopathy (HIE) --> CT findings? (3)
- loss of gray-white differentiation
- diffuse cerebral hypo
- sulcal efface
273
what is white cerebellum sign? dx?
hypoxic ischemic encephalopathy (HIE) --> cerebellum spared --> appear hyper compared to supratentorial brain
274
hypoxic ischemic encephalopathy (HIE) --> MRI findings?
- FLAIR
- DWI
- FLAIR hyper
| - DWI hyper
275
methanol poisoning --> charact imaging finding?
- putamen --> hemorrhagic necrosis
| - sparing of globus pallidus
276
carbon monoxide poisoning --> MRI appearance? hallmark imaging finding?
- FLAIR
- DWI
- SWI
bilat symm --> globus pallidus --> necrosis:
- FLAIR hyper w hypo rim
- restrict diff
- SWI hypo
277
osmotic demyelination --> predisposing conditions? (3)
poor nutritional status:
- alcoholic
- chronic lung dz
- liver tx recipient
278
Marchiafava-Bignami dz (MBD) --> predisposing conditions? (2)
- chronic alcohol
| - vit B complex def
279
Marchiafava-Bignami dz (MBD) --> charact finding?
corpus callosum --> demylination --> necrosis
280
metronidazole-induced brain toxicity --> charact imaging findings? MC locations? (5)
symm FLAIR hyper:
- cerebellar dentate nuclei
- corpus callosum splenium
- tegmentum
- dorsal pons
- dorsal medulla
281
methotrexate-induced brain toxicity --> charact imaging findings?
lesion --> bilat asymm --> white matter --> centrum semiovale --> cross vasc territory, spare subcortical U fibers:
- FLAIR hyper
- restrict diff
282
autoimmune encephalitis (autoimmune limbic encephalitis) --> categories? (2)
- paraneoplastic vs non-paraneoplastic
| - grp I (intracell antigen) vs II (cell surface Ag)
283
autoimmune encephalitis (autoimmune limbic encephalitis) --> grp I vs II --> which is more assoc w paraneoplastic synd?
grp I
284
autoimmune encephalitis (autoimmune limbic encephalitis) --> grp I vs II --> which has worse clinical outcome?
grp I
285
what is tuberculoma?
localized TB granuloma
286
tuberculoma --> MR appearance?
- T2
- DWI
- T2 central hypo
| - restrict diff
287
lyme dz --> imaging appearance?
nonspec --> frontal --> subcortical white matter --> T2 hyper
288
neonate --> TORCH infx --> CMV --> imaging findings? (4)
- brain atrophy
- encephalomalacia
- ventricle enlrg
- periventricular calcs
289
CMV infx --> MC CNS manifestation? (2)
- ventriculitis
| - meningoencephalitis
290
CMV ventriculitis --> charact imaging findings?
- subependymal FLAIR hyper
| - ventricular system enhance
291
intracranial abscess --> how to differentiate fungal vs bact abscess?
fungal abscess:
- crenated/lobulated border
- intracavitary projections --> nonenhance --> restrict diff
- core --> not restrict diff
292
CNS fungal infx --> cryptococcus --> MC clinical presentation?
chronic basilar meningitis
293
CNS cryptococcus --> charact imaging findings? (2)
- basal ganglia perivascular spaces --> gelatinous pseudocysts
- choroid plexus --> ring-enhancing granulomas (cryptococcomas)
294
neurocysticerosis --> 4 stages?
- viable/vesicular
- colloidal
- nodular/granular
- calcified
295
neurocysticerosis --> viable/vesicular stage --> imaging finding?
CSF-intensity cysts --> some may demonstrate eccentric "dot" (scolex)
296
neurocysticerosis --> colloidal stage --> imaging finding?
ring enhancing lesion --> inc diffusion
297
neurocysticerosis --> nodular/granular stage --> imaging finding?
cyst involute:
- cyst wall thicker
- dec edema
298
neurocysticerosis --> calcified stage --> imaging finding?
- small parenchymal calc
| - small foci of susceptibility
299
toxoplasmosis --> typical appearance? MC location?
basal ganglia --> ring enhancing lesion(s)
300
toxoplasmosis --> what is a not very sens, but relatively specific sign?
"asymm target" sign --> toxo lesion --> mural nodular enhance
301
immunocomp --> basal ganglia --> mass --> ddx? (2)
- toxo
| - CNS lymphoma
302
Creutzfeldt-Jakob dz (CJD) --> typical MRI appearance? 3 signs?
"cortical ribboning" --> cerebral cortex:
- FLAIR hyper
- restrict diff
"pulvinar" sign --> thalamus --> pulvinar nucleus --> bright FLAIR & DWI
"hockey stick" sign --> dorsomedial thalamus --> bright FLAIR & DWI
303
brain myelination --> which part of brain is last to myelinate?
subcortical white matter
304
brain myelination --> which part of brain is already myelinated at birth? (2)
- brainstem
| - internal capsule --> post limb
305
1 cerebral hemisphere --> enlrged --> enlrged ventricle --> dx?
hemimegalencephaly
306
chiari 1 --> occur ONLY in pt w neural tube defect --> T/F?
F --> not assoc w NTD
307
chiari 2 --> occur ONLY in pt w neural tube defect --> T/F?
T
308
chiari 3 --> occur ONLY in pt w neural tube defect --> T/F?
T
309
hot cross bun sign --> dx?
mult system atrophy - cerebellar subtype (MSA-C)
310
brain mass --> cortically-based --> ddx? (4)
P-DOG:
- pleomorphic xanthoastrocytoma (PXA)
- dysembryoplastic neuroepithelial tumor (DNET)
- oligodendroglioma
- ganglioglioma
311
1p/19q deletion --> brain tumor --> dx?
oligodendroglioma
312
CPA --> mass --> ddx? (3) in order
- #1 vestibular schwannoma
- #2 meningioma
- #3 epidermoid
313
dermoid vs epidermoid --> main difference?
- dermoid: behave like fat
| - epidermoid: behave like CSF
314
ped --> infratentorial --> cyst w nodule --> dx?
pilocytic astrocytoma
315
adult --> infratentorial --> cyst w nodule --> dx?
hemangioblastoma
316
mult hemangioblastoma --> dx?
VHL
317
gelastic sz --> dx?
hypothalamic hamartoma
318
bilat hippocampi --> symmetric --> T2/FLAIR hyper, restricted diffusion --> dx?
hypoxic-ischemic encephalopathy
319
deep venous system --> thrombosis --> infarct what area?
bilat thalamus
320
acute isolated bilateral thalamic infarcts --> which artery?
Artery of Percheron
